Peripheral Blood Eosinophilia Is Associated with Poor Outcome Post-Lung Transplantation.

Janne Kaes,Laurens Ceulemans,Geert Verleden,Elise Van Der Borght,Annelore Sacreas,Laurent Godinas,Arno Vanstapel,Robin Vos,Anke Van Herck,Stijn Verleden,Tobias Heigl,Arne Neyrinck,Dirk Van Raemdonck,Bart Vanaudenaerde

doi:10.3390/cells9112516

Abstract

Eosinophils play a role in many chronic lung diseases. In lung transplantation (LTx), increased eosinophils in bronchoalveolar lavage (BAL) was associated with worse outcomes. However, the effect of peripheral blood eosinophilia after LTx has not been investigated thoroughly. A retrospective study was performed including all LTx patients between 2011–2016. Chronic lung allograft dysfunction (CLAD)-free and graft survival were compared between patients with high and low blood eosinophils using an 8% threshold ever during follow-up. A total of 102 patients (27.1%) had high blood eosinophils (≥8%) (45 before CLAD and 17 after, 40 had no CLAD) and 274 (72.9%) had low eosinophils (<8%). Patients with high blood eosinophils demonstrated worse graft survival (p = 0.0001) and CLAD-free survival (p = 0.003) compared to low eosinophils. Patients with both high blood and high BAL (≥2%) eosinophils ever during follow-up had the worst outcomes. Within the high blood eosinophil group, 23.5% had RAS compared to 3% in the group with low eosinophils (p < 0.0001). After multivariate analysis, the association between high blood eosinophils and graft and CLAD-free survival remained significant (p = 0.036, p = 0.013) independent of high BAL eosinophils and infection at peak blood eosinophilia, among others. LTx recipients with ever ≥8% blood eosinophils demonstrate inferior graft and CLAD-free survival, specifically RAS, which requires further prospective research.

Highlights

Lung transplantation (LTx) is a life-saving treatment for selected patients with end-stage pulmonary diseases, such as emphysema, cystic fibrosis and pulmonary fibrosis
In the high eosinophil group, there were more patients with cystic fibrosis and/or bronchiectasis compared to the group with low eosinophils (p = 0.014)
We demonstrated that a high peripheral blood eosinophil percentage (≥8%) is associated with worse outcomes after LTx, i.e., a shorter graft and Chronic lung allograft dysfunction (CLAD)-free survival

Summary

Introduction

Lung transplantation (LTx) is a life-saving treatment for selected patients with end-stage pulmonary diseases, such as emphysema, cystic fibrosis and pulmonary fibrosis. Short-term survival post-LTx improved significantly due to changes in donor procedures (selection and preservation), perioperative. Cells 2020, 9, 2516 management and improved handling of post-operative complications. Long-term outcomes, are still lagging behind compared to the survival following other solid organ transplants. Complications hampering long-term survival after LTx are chronic lung allograft dysfunction (CLAD), cancer and side effects of the life-long necessary immunosuppression, e.g., infections and renal insufficiency [1]. CLAD is the major drawback, occurring in approximately 50% within five years after transplantation [2]. It is important to identify and avoid risk factors that contribute to the development of CLAD or other complications

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